Biased Clinical Instructor

[nurseinthemaking24, BSN, RN]

Hi yall, I could use some advice. 

I am currently taking my final course before I graduate and am going into my second to last clinical rotation.

Background: I am a student with ADHD that receives accommodations from my school's ADA officer. I have had ADHD since I was 13 years old and I have never once used it as an excuse because that simply isn't what it is. It is a unique difference in my brain, thought pattern, and learning/studying style in comparison to others. In fact, it is what many instructors have told me will make me a fantastic nurse, I have never had things easy for me. I have always had to study twice as hard and try six times as hard as the average student to obtain decent grades. This has given me so much resilience.

I have been in clinical settings since 2019 which a wide variety of different clinical instructors. I have never had a problem with any of them until this current instructor. Keep in mind that this instructor has known me for 2 full days and only known me for a maximum of 4 hours in total. She does know about my ADHD because the school sends out my accommodations. 

 

The story- 

I'm insanely frustrated and feel beaten down at this time. My instructor told me on Friday that she is not satisfied with my abilities and need to stop using my ADHD as an excuse and do better. What provoked this you may ask? I got distracted and jokingly said, ADHD probs then returned to my task because I felt the need to address my distraction. Me saying I cannot focus because I have ADHD is not an excuse, it is a statement, a true statement. In the clinical setting, I tend to ask for clarification to ensure that I am doing what I am supposed to be doing. This helps me to fully understand what is expected of me because sometimes I miss part of an instruction or hear the wrong thing. So it is important to me to ask for clarification. She wrote down that I am progressing with reminders, which is ironic because she has never once reminded me to do anything. I go to her and ask her to confirm, she tells me yes if I understood correctly and no if I did not. That is not her actively looking for me on the unit and having to remind me to check on my patient or a task. 

On top of that, there was a girl in my clinical group that didn't know how to do anything patient care wise. So once I finished with my patient, I went with her to show her how to do everything under the sun. She didn't know how to use the BP machines, nor what a MAP was, how to put a patient on a bedpan, change the patients chucks, etc. I had no problem showing her how to do these things, but of course I receive no credit whatsoever from my instructor. My instructor refuses to acknowledge anything I have done correctly and instead tells me all of my weaknesses at one time and tells me I am not doing my best and need to do better, "you understand?" 

On top of all of that, she kept reinforcing the fact that I need to do better and I'm not doing good enough. Giving me now credit from this point forward for anything I have actually done well. This is extremely discouraging to me because I know I provide fantastic patient-centered care. I am constantly receiving compliments from patients and patient family members for how well I am taking care of their loved ones. 

The reminder thing- Sometimes, she doesn't give a clear instruction to the point I ask the girls in my clinical what we are supposed to be doing and none of us have a clue so I go to ask her to clarify my understanding so I don't do something I am not supposed to be doing. this is what she classifies as "reminders," I approach HER to clarify. That is not a reminder to me.

It really frustrates me because I try so hard and it isn't recognized at all. 

 

[NICU Guy, BSN, RN]

On 7/18/2021 at 4:53 PM, nurseinthemaking24 said:

My instructor told me on Friday that she is not satisfied with my abilities and need to stop using my ADHD as an excuse and do better. What provoked this you may ask? I got distracted and jokingly said, ADHD probs then returned to my task because I felt the need to address my distraction.

The fact that you used your ADHD problems in a joking, flippant manner may have been interpreted by her as using it as an excuse. You do not need to address your ADHD distractions unless you are addressing them in a serious manner with your instructor.

[nurseinthemaking24, BSN, RN]

I probably should’ve clarified that I said this as a joke to one of my friends/peers in the conference room and it wasn’t referring to nursing at all. 
I have accommodations as a student so she was aware of those explicitly. But she told me I needed to try harder than I am which really bothered me because I really do try so hard

[JKL33]

So...this might be a little here and there. Obviously I know neither you nor your instructor. So I am going to speak in some generalities according to observations I've made over years' time.

You need to:

1. Tighten up every loosey-goosey thing that you can. In general keep yourself in check. Be serious, be straightforward, comport yourself as a professional-in-training. Be on task at all times. Keep socializing of any kind to a minimum. If there is down-time, be seen researching your patients' charts so you can better understand the progression of their condition or hospitalization.

2.

On 7/18/2021 at 4:53 PM, nurseinthemaking24 said:

So once I finished with my patient, I went with her to show her how to do everything under the sun.

Stop this type of activity for the most part. When you do things like this (especially the words you have used to portray it) you give others the impression that showing off the simple things you already know might be more important to you than learning. You have plenty of your own things to keep track of and make sure you're understanding correctly; you actually are not in the best position to worry about whether your peer knows how to do these things or not. That is for the instructor to worry about and you are not part of that process. Your most important jobs are to learn about taking good care of patients and to show your instructor that you are capable and are serious about your own learning.

I am not trying to lecture you and I'm sure it's hard to read this because you may have felt very good about being able to help out a peer, I just want you to understand that the type of activity you describe (so-and-so doesn't know anything and I had to show them how to do every single thing) draws negative attention in general.

3.

On 7/18/2021 at 4:53 PM, nurseinthemaking24 said:

This is extremely discouraging to me because I know I provide fantastic patient-centered care.

You currently provide student-level care. You are not at any appropriate stage to challenge an instructor based on the care you think you provide. If you are indeed focused on patients that is wonderful and that means you are on the right track. I am a little concerned about the words you are using to describe your performance. If your instructor has picked up on any of this then the question of why she is already dogging you is pretty much answered. I mean this in your best interest but you need to tone it down. ??

Please consider the above items.

At your next clinical day, start off on the right foot. Forget today's frustration. Be pleasant and serious/on-task with your instructor.

GOOD LUCK! ?

[Golden_RN, MSN]

I had an instructor straight up tell me that I did not have the personality to be successful in nursing, so I know it feels devastating to have an instructor dislike you or be on top of you.  You've already been given some great advice, & here is mine:

1. Be serious at all times.  This instructor doesn't seem to appreciate joking around.

2. It's wonderful that patients/families appreciate you.  That probably means you're attentive and providing comfort.  However that does not mean you're operating at the level of an RN in terms of pathophys, advanced skills, critical thinking, multitasking & other skills that your instructor is looking for.  Bed pans and VS are 1st semester/CNA level skills.  If your work is caught up, review your patients' pharmacology, care plans, pathophys, whatever.  Teaching another student CNA level skills does not advance you at this point.

3. If your instructor is giving instructions at the beginning of clinicals, write them down.  Ask clarifying questions right then.  It doesn't look great if during the shift you ask, "What are we supposed to be doing?"

Finally, this is your final semester and your teacher has the responsibility to make sure that in a few short months you have the ability to practice safely as a novice nurse.  It SHOULD be difficult.  You're almost at the finish line so jump through whatever hoops you have to jump through.  I hope it gets better.

[caliotter3]

My school had a clinical instructor who also taught in the final semester.  She concentrated on identifying students to fail to graduate.  She did not make this known to any students until they were sitting in her office being told that she was failing them for their clinical course and that it was her duty to see that they did not graduate.  Previous posts have mentioned possible areas where such an instructor would be getting valuable input with their gatekeeper mission in mind.  If I would have been aware of the time you took playing mentor to your classmate, I would have been somewhat angry that you were not constructively using your PERSONAL STUDENT time wisely.  Now is not the time to be getting on anyone's radar.  Get on task.

[nurseinthemaking24, BSN, RN]

I thank you all for the feedback, I will keep this in mind for my clinical on Friday. I feel like it is hard for me to do things such as read my patient's chart and do things via their EHR because we do not have long in abilities like I have at previous clinical sites. Normally, that is my number #1 go to thing to do when my patient is taken care of and there are no other tasks for me to do. I have decided to make myself a little schedule chart based off how things have gone the past two weeks. She gives us times to do A,B,C so I feel like having that all written down will help me a lot. 

I understand the personal student time and how it could be seen that I was maybe playing mentor to another student, doing CNA level takes. I understand that in other perspectives it could be frustrating, but she has told us time and time again that we are supposed to help each other. But in the event that maybe I need to stop and not worry about my peers to prioritize my personal learning needs, how do I say no when someone comes to me and asks me for help? I know that sounds insanely bad, I do know how to say no. But when it comes to helping others I have always been told to help in clinicals. So I am not sure how to go about this.

 

I appreciate all of your comments, thoughts and perspectives. I reallly appreciate each of you :) 

[JKL33]

You are welcome!

21 minutes ago, nurseinthemaking24 said:

I feel like it is hard for me to do things such as read my patient's chart and do things via their EHR because we do not have long in abilities like I have at previous clinical sites.

That is terrible, very sorry to hear this. I don't think it is appropriate for a student experience at all, especially final clinicals.

22 minutes ago, nurseinthemaking24 said:

how do I say no when someone comes to me and asks me for help?

Make your first judgment based on where you are in your work with your patients. If any of your peers' requests are going to put you off-task then politely defer ("I could help you when I'm done with [xyz]" or "Sorry I can't right now, I am going to CT with my patient" or even just "I'm sorry, I really can't right at the moment"). However, if you are right on top of every single thing on your patients' agendas and you truly do have 5 minutes to help someone, then do it. Get right back to your patient's vicinity when you are finished. In general just don't be in the wrong place at the wrong time. Don't show up to post-conference late because xyz, don't be found in someone else's room when your patient isn't taken care of, etc., etc.

I hesitate to suggest this because I typically only make these kinds of decisions by reading people in-person, but you might consider an attempt to get back on track (in your instructor's eyes) by finding a moment next clinical day to let her know that you have spent quite a bit of time reviewing your performance and her suggestions and hope she will notice an improvement. *This is sorta risky because some maladjusted people just attack even more fiercely if they smell blood in the water. So you will have to think it through and use good judgment here.

You'll be okay. Don't get too anxious about all this. Review what we have said, review all that has happened, make your plan and go in zen.

??

[2BS Nurse, BSN]

In clinical, just do your job and fly under the radar as much as possible! 

[Golden_RN, MSN]

21 hours ago, nurseinthemaking24 said:

I understand the personal student time and how it could be seen that I was maybe playing mentor to another student, doing CNA level takes. I understand that in other perspectives it could be frustrating, but she has told us time and time again that we are supposed to help each other. But in the event that maybe I need to stop and not worry about my peers to prioritize my personal learning needs, how do I say no when someone comes to me and asks me for help? I know that sounds insanely bad, I do know how to say no. But when it comes to helping others I have always been told to help in clinicals. So I am not sure how to go about this.

It's tough to answer this without knowing the instructor.  Some instructors are just jerks.  Some just might dislike certain students for whatever reason.

If your classmates know you're on your instructor's *** list, they'll understand that you need to totally stay on task.  And if by the final semester they don't know how to do basic tasks, that's not your fault.  ?

[Leader25, ASN, BSN, RN]

On 7/18/2021 at 4:53 PM, nurseinthemaking24 said:

I receive no credit whatsoever from my instructor. My instructor refuses to acknowledge anything I have done correctly and instead tells me all of my weaknesses at one time and tells me I am not doing my best and need to do better, "you understand?" 

you have much to learn oh little Jedi.

you are not a nurse yet,but someday you will be,learn now that it is sometimes a thankless job.Stop expecting the teacher to be your cheerleader mommy,the toughest teachers produce the best nurses.I have seen and experienced much worse,seen my classmates wheeled down to the ER from  the stress in clinicals with "certain" instructors.

The first week they usually yell and tell everyone that they will fail.Although you are doing your work OK,you are not fantastic yet,you must graduate,do your work without the safety net of an instructor and shoulder entire responsibility for some ones life...then you will know what it means to have the letters RN after your name.Good luck ,do well,work hard.

[Conqueror Slothful]

On 7/21/2021 at 6:46 PM, 2BS Nurse said:

In clinical, just do your job and fly under the radar as much as possible! 

Probably the best advice so far.